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General NPI Number Information
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NPI Number | 1265069165
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Entity Type | Individual
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Provider Name | ANDRES VAZQUEZ M.S.
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Gender | Male
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Dates
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Enumeration Date | 03/23/2020
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Last Update Date | 03/23/2020
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Provider Practice Location Address
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Address Line | 5745 MAIN ST
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-2737
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Country | US
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Telephone | 813-458-8831
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Fax |
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Provider Business Mailing Address
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Address Line | 9340 LAKE CHASE ISLAND WAY
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City | TAMPA
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State | FL
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Zip | 33626-1932
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Country | US
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Telephone | 813-458-8831
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH19338
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License Number State | FL
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